National Home Care Aide Week

November is National Home Care and Hospice month, and although Elder Care Guides is not a home care company, we want to recognize and illuminate our wonderful employees, the professional caregivers. The National Association for Home Care and Hospice has named November 8th - 14th National Home Care Aide week, with the theme "Home Care Aide: Loving Hands and Compassionate Hearts." This special month and week was announced to bring attention to and celebrate those to spend their lives caring for others. A noble profession, caregiving doesn't often get the attention it deserves. Care Management support, a personalized care plan, and the expert care of a professional caregiver is what allows the growing elderly population to stay at home much longer than originally thought possible.

There are many ways to contribute to and acknowledge that special caregiver in your life, and we encourage you to branch out this month to increase awareness of this much valued career.

• Educate yourself about Care Management and Caregiving by requesting books and materials on the topic at your local library.


• Pass out small gifts or tiny treats to volunteers and caregivers at a local assisted or independent living retirement communities.


• Talk about Care Management with your neighbors and friends who may be struggling in the sandwich generation and don't know where to find help.

As you go about your days in November, stop and notice all the caregivers that surround you. These amazing people are sitting with an elderly person at a restaurant, helping them with their meal. They are reaching for an item on a high shelf at the grocery store for a person in a wheelchair. Every day, they are giving of themselves physically, emotionally, and spiritually, all to assist another person to live with dignity and purpose. To the professional caregivers, we salute you. Happy National Home Care Aide week!

Looking "Up"

On a recent cross-country flight, I enjoyed the opportunity to watch Disney/Pixar's most recent animated feature, "Up." The main character, Carl, is an elderly and childless man who, upon losing his wife Ellie with whom he'd led a long and happy life, finds himself being forced out of their beloved little house and into a retirement home when he is deemed a "public menace." He and his wife had an unfulfilled, lifelong fantasy of moving to a place called Paradise Falls in South America, and on the day the staff from the retirement home come to take him, Carl ties hundreds of balloons to his house and flies away in pursuit of his and Ellie's dream. Once in the air, he realizes he's accidentally taken along a neighborhood boy, Russell, who had been on his porch attempting to earn a merit badge for "assisting the elderly." The movie is focused on the adventures that Carl and Russell experience while in South America (and I won't spoil the plot, for those who haven't seen it!), but it brought to light some issues and themes about which I often reflect both as a professional geriatric care manager, and as a person who cares deeply about the inner lives of our elders.

Carl is a cantankerous old grump of a character, and Russell is a loud, high-energy schoolboy and "Wilderness Explorer" scout. Through the course of their journey, we learn that Russell is being raised by his single mother, and wishes he spent more time with his re-married father. Russell eventually endears himself to his aged traveling companion, and a deep friendship is born. They learn about the world and about life from one another, and fulfill important roles in each other's lives. It is a sweet demonstration of the value of intergenerational relationships, and I hope that "Up's" younger audiences will internalize this lesson and seek out friendships with the elders in their communities, and value time spent with their own parents, grandparents, aunts, and uncles.

When Carl and Russell's balloon-powered house lands in South America, they realize that they've made it close to Paradise Falls, but have an arduous journey ahead of them, to relocate the house to the precise spot about which he and Ellie had dreamed. When faced with a difficult choice, Carl comes to the realization that "it's just a house." Until then, he had been very focused on it, and the things therein, as essential to his happiness and to the fulfillment of this particular dream. This brings to mind the complex relationship that many elders have with their family homes, as symbols of independence and a source of connection to memories and former roles and relationships. For my own grandmother, leaving her house meant not only accepting a new type of dependence on others, but relinquishing an important role - her home would no longer be the gathering place for celebrations and holidays, and she would no longer be able to provide a warm meal or a bed for visiting friends and family. Warm hospitality was a central feature of my grandmother's character, and looking back with hindsight, I wish we'd found more ways as a family to continue to foster that part of her after she moved into her assisted living apartment. For my grandmother, and for many others, letting go of her house felt like a loss of independence, but was in reality only a shift to a new type of interdependence.

The most important message I received from "Up" was that setting goals and achieving dreams is an ongoing process that should take place throughout our lives. Carl and Ellie had dreamed of children - and did not have them. They had dreamed of Paradise Falls - and did not get there. But they adapted to their circumstances, set new goals, and lived a happy and full life together. When things are looking grim in South America, Carl finds a message that Ellie had left for him before her death, which reads "Thanks for the adventure - now go have a new one!" and is renewed in his efforts. Carl's dreams of a life in South America with his beloved Ellie were not realized, but through the journey and his friendship with Russell, a new purpose for his later life was revealed. We see this in our work with our clients, and know it to be true: we are always growing, it is never too late to set and achieve goals, and there is purpose in every moment lived.

Flu Season is Here

The new strain of the flu virus, H1N1, is making headlines. On the radio, on the television news, in the newspaper, and online we are told the nasty virus is coming, and it's time to get ready. Just like any disease, the best way to battle it is prevention. Here are a few helpful tips on how to battle the flu, before it reaches you.

• Wash your hands: Hand washing is the number one way you can prevent the spread of disease. Wash frequently, for at least 20 seconds. If a sink is not nearby, an alcohol based sanitizer will do the trick.



• Take Vitamin D: Exposure to the sun helps in getting your daily dose of this important vitamin, but winter makes that more difficult. Make sure vitamin D is in your daily dose, as it has been proven to reduce the likelyhood of the flu.



• Eat Probiotics: Probiotics are good bacteria found in fermented food such as yogurt and soy. Promoting a healthy balance of bacteria will help in digestion, and boost immune fighting chemicals in your body.



• Eat Fruits and Veggies: This is a good idea all year round, but loading up your body with immune fighting phytochemicals found in these foods is essential during flu season.



• Get Vaccinated: Although the National Institutes of Health does not have the H1N1 vaccine ready for widespread use, you can still get the general flu vaccine now.

The new Dr. Oz Show recently featured the flu on a recent broadcast, and gave several more helpful suggestions on how to prevent it. The three most important groups of individuals who should get the flu vaccine immediately are pregnant women, young children, and those in the healthcare industry. Elder Care Guides is doing what we can to inform our clients and caregivers of this important information, and encouraging them to incorporate these preventative measures. Sending out a flyer of information, offering to reimburse for the cost of the vaccine, and reminders during home visits are a few ways we have helped.

Here's to your health!

Care Management Featured in the New York Times

An article titled "When Elder Care Problems Escalate, You Can Hire an Expert" appeared in Saturday's New York Times Health Section (9/26/09). It provides some excellent, concrete examples of situations in which the interventions of a professional geriatric care manager can make a positive impact on the lives of elderly parents and their adult children who are caring for them. The author provides some guidelines for identifying a good match, and a list of questions to ask when interviewing a professional geriatric care manager.

We encourage families to call Elder Care Guides with their list of concerns, and the particular criteria they seek in a care manager for their aging parent. We welcome the opportunity to meet face-to-face at our office or in a parent's home at no charge, to discuss the needs and how the services of a care manager may be of assistance, and to determine whether there is a good personal "fit" between the family and the care manager.

Our Greatest Teachers

Last Thursday September 17th, we celebrated five years of service to San Diego County with several dozen of our friends and colleagues from the community. We enjoyed a beautiful late-summer evening on the promenade in Liberty Station, with food, wine, networking, and our delightful guest speaker, Marsha Kay Seff.

When we created Elder Care Guides in July of 2004, our goal was to design a care management system that does more than simply respond to the needs of the aging population. A skilled care manager can assess an unrecognized need before it becomes a crisis, and we have worked hard to remain flexible and nimble in the face of the constantly-changing needs of our clients and their representatives, and as the larger landscape of long term care undergoes significant changes. We provide services with a spirit of support and collaboration, and our community has responded.

When I asked Marsha to speak on the topic of the hidden powers of elders, she replied with the question, "What is hidden about their powers?" Through beautiful stories about her own parents, as well as the others she has had the good fortune to know through her quarter century of working and writing in San Diego's elder care community, Marsha painted a portrait of "geysers" (not "geezers") who continue to learn and teach, volunteer and contribute in their communities, participate politically, and leave important legacies to their families.

Through the years, we have learned that the challenges of aging are not something to be simply "managed," but that they are a gift, a set of strengths and resources from which we and our clients can learn and continue to grow. We thank everyone who joined us for being a part of an evening that was very special to all of us, and held those who could not be with us close to our hearts.

Preventing Suicide Amongst Elders

National Suicide Prevention Week is observed September 6th through September 12th, with World Suicide Prevention Day falling on September 10th.

Older adults are at great risk for depression and suicide. Consider the following statistics from the National Strategy for Suicide Prevention:

• The highest suicide rates of any age group occur among persons aged 65 years and older.
• Suicide disproportionately impacts the elderly. In 1998, this group represented 13% of the population, but suffered 19% of all suicide deaths.
• Firearms (71%), overdose [liquids, pills or gas] (11%) and suffocation (11%) were the three most common methods of suicide used by persons aged 65+ years.
• In 1998, men accounted for 84% of suicides among persons aged 65 years and older.
• It is estimated that 20% of elderly (over 65 years) persons who commit suicide visited a physician within 24 hours of their act and 41% visited within a week of their suicide.

Older adults as a group have special characteristics that contribute to a their risk for suicide:

• Suicide rates in the elderly are highest for people who are divorced or widowed.
• Elders have a higher prevalence of depression versus the general population, putting them at higher risk for suicide.
• Older adults are frequently isolated due to physical disability, lack of transportation, or separation from family, which can contribute to feelings of loneliness and depression.
• Seniors use more lethal methods for suicide, resulting in more deaths from suicide.

Health care providers and families can be alert for the following signs and symptoms of depression or possible suicidal ideation:

• Talking about suicide or death.
• Giving verbal cues such as "I wish it were all over," or " What's the point of going on?"
• Isolating oneself from friends of family, or not participating in activities that were once meaningful.
• Giving away personal belongings that have value to that person.
• Neglecting hygiene or personal appearance.
• Demonstrating a sudden improvement of mood or outlook after a period of "the blues" or depression (this can indicate that the individual has created a plan for suicide).
• Having firearms, medications, or other toxic substances on hand.

If you notice a loved one or someone close to you with these symptoms, you should talk to them about their feelings. It is a common misconception that talking to someone about suicide will lead that person to hurt themselves.

If you are having symptoms of depression or thoughts of suicide, talk to your doctor, another health or mental health provider, or call the San Diego Suicide Hotline at 1-800-479-3339. If you need help urgently, call 911.

Geriatric Care Management: A Profession, and Not Just a Business

I recently received an inquiry from someone considering starting a business managing the medical, legal, and financial affairs of retirees, who sought my feedback regarding the feasibility of such a consultancy. He has several years of experience managing his father's affairs, and a business education; he is a person that I know, and for whom I have a great deal of professional respect. I sat down and sent him a thoughtful response and, when it was sent, realized it was a great reflective exercise that may have some value to others. And so I decided to post parts of it here (with adaptations made for a wider audience) as an open letter to those who would consider a career in this unique service to our aging population:


Care management is more than an interest in the well-being of elders, or a passion for service. It is a profession, and requires education and supervised experience, as well as a healthy dose of discretion -- we need to know what we don't know, and work collaboratively with others to create a support system that protects and honors the elder client. The management of an individual's medical, financial, and legal affairs should not be provided by one person or organization (unless it is under the careful supervision of the courts), and while it's generally acceptable - although not ideal - for an individual family member to serve in multiple roles when necessary, it is inappropriate for a professional to do so. A single entity that helps members of this vulnerable population make decisions regarding their long-term care, provides and/or manages those services, and then arranges for payment to be made for the services has a very clear conflict of interest and a lack of objectivity.

As geriatric care managers, we are usually the hub of a team of professionals working together in service to our client, often alongside devoted and hard-working family members. We assess and manage medical, psychiatric, cognitive, social, and care needs, while private fiduciaries manage financial affairs and can serve as legal representative (power of attorney, conservator, guardian, etc.) when necessary. Estate planning and elder law attorneys assist in the preparation and continuous update of documents such as the estate plan and advanced directives, and there are often other professionals involved as well, including financial advisers or trust administrators.

This might all sound like overkill (does one client really need all of these people involved in their affairs?), but the fact is that young and healthy seniors do not want or need this type of assistance. Families that hire care managers are usually dealing with complex circumstances, often after years of familial strife and decline due to advanced age and a chronic, disabling condition (usually several). Every day, we are negotiating long-standing family conflicts, working with physicians regarding complicated medical conditions and treatments in an increasingly fragmented health care system, and shepherding people through the spiritual journey at the end of their lives, helping them continue to find meaning and purpose. These are not simple transactions.

As an adult child, one has the time (albeit limited) to do one's research, to learn what needs to be known about a parent's health insurance coverage, medical conditions, and financial/legal affairs as one goes along. There is also an understanding, a permission of sorts, to make mistakes along the way: to hire a home care company that did not fulfill their commitments, to churn through several health care providers before finding the one with the right skills to manage your loved one's medical situation. Expert consultants do not have this time or permission. Families rightfully expect a paid professional geriatric care manager to understand the national and local health care landscape, to know which facilities in their area provide the best dementia care, how to effectively supervise in-home caregivers, which medications are considered unsafe for elders according to the Beers criteria, the basics of applying for Medicaid, how to help a conflicted family reach consensus regarding a plan of care, etc. When we come to a new client untrained in these issues, or without the skills to efficiently obtain necessary information or services, we are not being good stewards of their resources. Experience as a family caregiver is an enormous asset to a professional geriatric care manager, but it is not enough.

My advice (for those who would seek it) is to find a service niche that makes the best use of your interests and skills, and seek out the education, training, experience, and certification/licensure that is required. It is a road that may take several years, but it will be a rewarding journey that will serve you and your clients in countless ways.

For more information, please visit the websites of the National Association of Professional Geriatric Care Managers, and the National Guardianship Association.